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Lee PH, Hong SJ, Kim HS, Yoon YW, Lee JY, Oh SJ, Lee JS, Kang SJ, Kim YH, Park SW, Lee SW, Lee CW. Quantitative Coronary Angiography vs Intravascular Ultrasonography to Guide Drug-Eluting Stent Implantation: A Randomized Clinical Trial. JAMA Cardiol 2024; 9:428-435. [PMID: 38477913 PMCID: PMC10938248 DOI: 10.1001/jamacardio.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/16/2023] [Indexed: 03/14/2024]
Abstract
Importance Although intravascular ultrasonography (IVUS) guidance promotes favorable outcomes after percutaneous coronary intervention (PCI), many catheterization laboratories worldwide lack access. Objective To investigate whether systematic implementation of quantitative coronary angiography (QCA) to assist angiography-guided PCI could be an alternative strategy to IVUS guidance during stent implantation. Design, Setting, and Participants This randomized, open-label, noninferiority clinical trial enrolled adults (aged ≥18 years) with chronic or acute coronary syndrome and angiographically confirmed native coronary artery stenosis requiring PCI. Patients were enrolled in 6 cardiac centers in Korea from February 23, 2017, to August 23, 2021, and follow-up occurred through August 25, 2022. All principal analyses were performed according to the intention-to-treat principle. Interventions After successful guidewire crossing of the first target lesion, patients were randomized in a 1:1 ratio to receive either QCA- or IVUS-guided PCI. Main Outcomes and Measures The primary outcome was target lesion failure at 12 months, defined as a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. The trial was designed assuming an event rate of 8%, with the upper limit of the 1-sided 97.5% CI of the absolute difference in 12-month target lesion failure (QCA-guided PCI minus IVUS-guided PCI) to be less than 3.5 percentage points for noninferiority. Results The trial included 1528 patients who underwent PCI with QCA guidance (763; mean [SD] age, 64.1 [9.9] years; 574 males [75.2%]) or IVUS guidance (765; mean [SD] age, 64.6 [9.5] years; 622 males [81.3%]). The post-PCI mean (SD) minimum lumen diameter was similar between the QCA- and IVUS-guided PCI groups (2.57 [0.55] vs 2.60 [0.58] mm, P = .26). Target lesion failure at 12 months occurred in 29 of 763 patients (3.81%) in the QCA-guided PCI group and 29 of 765 patients (3.80%) in the IVUS-guided PCI group (absolute risk difference, 0.01 percentage points [95% CI, -1.91 to 1.93 percentage points]; hazard ratio, 1.00 [95% CI, 0.60-1.68]; P = .99). There was no difference in the rates of stent edge dissection (1.2% vs 0.7%, P = .25), coronary perforation (0.2% vs 0.4%, P = .41), or stent thrombosis (0.53% vs 0.66%, P = .74) between the QCA- and IVUS-guided PCI groups. The risk of the primary end point was consistent regardless of subgroup, with no significant interaction. Conclusions and Relevance Findings of this randomized clinical trial indicate that QCA and IVUS guidance during PCI showed similar rates of target lesion failure at 12 months. However, due to the lower-than-expected rates of target lesion failure in this trial, the findings should be interpreted with caution. Trial Registration ClinicalTrials.gov Identifier: NCT02978456.
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Affiliation(s)
- Pil Hyung Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Jun Hong
- Cardiovascular Center, Department of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Hyun-Sook Kim
- Department of Cardiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young won Yoon
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jin Oh
- Department of Cardiology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jin Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ahn JM, Kang DY, Kim JH, Choi Y, Kim H, Lee J, Park DW, Park SJ. Prognostic Value of Poststenting Fractional Flow Reserve After Imaging-Guided Optimal Stenting. JACC Cardiovasc Interv 2024; 17:907-916. [PMID: 38599694 DOI: 10.1016/j.jcin.2024.01.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 12/29/2023] [Accepted: 01/30/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Prognostic value of poststenting fractional flow reserve (FFR) remains uncertain in patients undergoing an imaging-guided optimal stenting strategy. OBJECTIVES The authors evaluated the prognostic value of poststenting FFR according to the intracoronary imaging-guided lesion preparation, stent sizing, and postdilation (iPSP) strategy to optimize stent outcomes. METHODS Poststenting FFR assessment was performed in 1,108 lesions in 1,005 patients from the IRIS-FFR registry. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization at 5 years. RESULTS At the index procedure, 326 lesions (29.4%) were treated using all 3 parts of the iPSP strategy. In the overall population, poststenting FFR was significantly associated with the risk of TVF at 5 years (per 0.01 increase of FFR, adjusted HR [aHR]: 0.94; 95% CI: 0.90-0.98; P = 0.004). Significant interaction was detected between poststenting FFR and the iPSP strategy on the risk of TVF at 5 years (P = 0.045 for interaction). In the iPSP group, poststenting FFR was not associated with the risk of TVF at 5 years (per 0.01 increase of FFR, aHR: 1.00; 95% CI: 0.96-1.05; P = 0.95), whereas a significant association between poststenting FFR and TVF at 5 years was observed in the no iPSP group (per 0.01 increase of FFR, aHR: 0.94; 95% CI: 0.90-0.99; P = 0.009). CONCLUSIONS Poststenting FFR showed a significant association with cardiac events. However, its prognostic value appeared to be limited after the application of an imaging-guided optimal stenting strategy.
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Affiliation(s)
- Jung-Min Ahn
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Do-Yoon Kang
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeonwoo Choi
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hoyun Kim
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinho Lee
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Mansour HM, Mohamed AM, Ibrahim SG, Ibrahim AM, Mohamed RG. Value of stent boost imaging in decision making after coronary stenting. Int J Cardiovasc Imaging 2023; 39:2557-2566. [PMID: 37845408 PMCID: PMC10692007 DOI: 10.1007/s10554-023-02961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Several studies reported the comparability of digital stent enhancement techniques (including stent boost imaging) in detecting suboptimal results of coronary stenting with Intra Vascular Ultrasound and optical coherence tomography. AIMS to assess results of stent deployment and determine the incidence of suboptimal results requiring changing final decision using stent boost imaging. METHODS This cross-sectional study included 120 patients eligible for PCI were recruited during a period of one year (January 2021 to 2022) using DES. RESULTS Suboptimal results were found in 38% of the PCI cases with stents (angiography guided). Importantly it was found that improper lesion preparation in our practice could not help improving stent optimization. Also, angiography guided PCI has significant incidence of suboptimal results. Digital stent enhancement techniques like stent boost have significant and important value in better decision making. After adjusting for age and sex, six factors were identified as independent predictors for final decision change (stent length, LAD/RCA affection, proximal segment affection, calcification, and optical coherence tomography. CONCLUSION This study has confirmed the utility of stent boost for the optimization of PCI in daily practice. Stent Boost is a simple and costless technique that provides an accurate assessment of a deployed stent without extending the procedure time and without more risk. It appears to be useful for the immediate evaluation of stent expansion and optimization of PCI by additional post-dilatation, when appropriate. Future studies are needed to determine whether Stent Boost data will correlate with adverse long-term clinical outcomes in patients undergoing PCI.
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Affiliation(s)
- Hossam M Mansour
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| | - Ahmed M Mohamed
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt.
| | - Soliman G Ibrahim
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman M Ibrahim
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| | - Ramadan G Mohamed
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
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Slingerland SR, van Beek KAJ, Schulz DN, van Steenbergen GJ, Brouwer T, Stoel M, Vlaar PJ, Tonino PA, Dekker L, van Nunen LX, Teeuwen K, van Veghel D. Results of systematic patient outcome monitoring: Does post-dilatation during angiography-guided percutaneous coronary intervention improve clinical outcomes? Hellenic J Cardiol 2023:S1109-9666(23)00223-3. [PMID: 37979617 DOI: 10.1016/j.hjc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/21/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023] Open
Abstract
OBJECTIVES This study evaluates clinical outcomes after implementing a liberal post-dilatation strategy during PCI. BACKGROUND Post-dilatation after percutaneous coronary intervention (PCI) is performed to achieve optimal stent expansion and reduce complications. However, its prognostic effects are unclear and conflicting. METHODS This study is a pre-post-intervention analysis of two cohorts, before (2015-2017) and after (2018-2020) implementation of a liberal post-dilatation strategy. The primary end point consisted of major adverse cardiovascular events (MACE) at 30 days. Secondary end points consisted of the individual components of the primary end point as well as 1 year mortality and target vessel revascularization. RESULTS A total of 10,153 patients were included: 5,383 in the pre-cohort and 4,770 in the post-cohort. The 30-day MACE was 5.00% in the pre-cohort and 4.09% in the post-cohort (p = 0.008; OR 0.75 (CI 0.61-0.93)). There was a significant difference between the pre- and post-cohort in 30-day mortality, respectively, 2.91% and 2.25% (p = .01; OR 0.70 (CI 0.53-0.93)), and MI at 30 days, 1.17% versus 0.59% (p = .003; OR 0.49 (CI 0.31-0.78)). At 1 year, there was a significant difference in mortality between the pre-cohort, 5.84%, and post-cohort, 5.19% (p = .02; OR 0.79 (CI 0.66-0.96)). CONCLUSIONS A liberal post-dilatation strategy after PCI was associated with a significant decrease in 30-day MACE, 30-day MI, 30-day mortality, and 1-year mortality. Future studies are warranted to validate the causality between post-dilatation and improvement of clinical outcomes.
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Affiliation(s)
| | | | | | | | - Tim Brouwer
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Martin Stoel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Pim A Tonino
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Lukas Dekker
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Lokien X van Nunen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen Teeuwen
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
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5
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Al-Alawy K, Sayegh KA, Moonesar IA. Optimizing interventional cardiology services. Future Cardiol 2023; 19:695-705. [PMID: 37916604 DOI: 10.2217/fca-2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023] Open
Abstract
Cardiovascular disease (CVD) is a common and prominent cause of morbidity and mortality interventional cardiology (IC) remains an important noninvasive intervention to improve patient outcomes and life expectancy. Aim: The study objectives were to explore how IC services could be optimized. Methods: We adopted multiple methods, including policy analysis, literature review and interviews. Results: The most prominent themes were medical devices and service integration and management. IC Consultant interviews suggest the need to balance supply and demand, implement standards of practice and establish centres of excellence. Conclusion: Optimizing IC services requires a comprehensive approach, including regulatory and financial oversight, organizational management, adoption of clinical and technological best practices, ongoing training, multidisciplinary working and service integration.
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Ali ZA, Karimi Galougahi K, Thomas SV, Abu-Much A, Chau K, Dakroub A, Shlofmitz ES, Jeremias A, West N, Matsumura M, Mintz GS, Maehara A, Shlofmitz RA. Optical Coherence Tomography-Guided Percutaneous Coronary Intervention: Practical Application. Interv Cardiol Clin 2023; 12:215-224. [PMID: 36922062 DOI: 10.1016/j.iccl.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Optical coherence tomography (OCT) provides high-resolution imaging of coronary arteries and can be used to optimize percutaneous coronary intervention (PCI). Intracoronary OCT, however, has had limited adoption in clinical practice. Novelty and relative complexity of OCT interpretation compared with the more established intravascular ultrasound, lack of a standardized algorithm for PCI guidance, paucity of data from randomized trials, and lack of rebate for intravascular imaging have contributed to the modest practical adoption of OCT. We provide a practical step-by-step guide on how to use OCT in PCI, including device set-up, simplified image interpretation, and an algorithmic approach for PCI. optimization.
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Affiliation(s)
- Ziad A Ali
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA.
| | - Keyvan Karimi Galougahi
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Susan V Thomas
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Arsalan Abu-Much
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Karen Chau
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Ali Dakroub
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Evan S Shlofmitz
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA; Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Nick West
- Abbott Vascular, 3200 Lakeside Drive #5314, Santa Clara, CA 95054, USA
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10029, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St Francis Hospital, 100 Port Washington Boulevard, Roslyn, NY 11576, USA
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7
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Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: Evidence and Clinical Trials. Interv Cardiol Clin 2023; 12:177-185. [PMID: 36922059 DOI: 10.1016/j.iccl.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) that was associated with improved post-procedural outcomes and long-term clinical outcomes has shown benefits not only in patients with complex lesions but also with simplex lesions. However, the use of IVUS during PCI remains low; therefore, further prospective, randomized, controlled trials are required to strengthen the recommendations and consequently expand its usage. The aim of this review is to discuss the previous evidences and clinical trials regarding IVUS-guided PCI and to discover the necessity for future studies to broaden its use in the real-world clinical practice.
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Osborn EA, Johnson M, Maksoud A, Spoon D, Zidar FJ, Korngold EC, Buccola J, Garcia Cabrera H, Rapoza RJ, West NEJ, Rauch J. Safety and efficiency of percutaneous coronary intervention using a standardised optical coherence tomography workflow. EUROINTERVENTION 2023; 18:1178-1187. [PMID: 36373421 PMCID: PMC9936255 DOI: 10.4244/eij-d-22-00512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/05/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND While intravascular imaging guidance during percutaneous coronary intervention (PCI) improves outcomes, routine intravascular imaging usage remains low, in part due to perceived inefficiency and safety concerns. Aims: The LightLab (LL) Initiative was designed to evaluate whether implementing a standardised optical coherence tomography (OCT) workflow impacts PCI safety metrics and procedural efficiency. METHODS In this multicentre, prospective, observational study, PCI procedural data were collected over 2 years from 45 physicians at 17 US centres. OCT-guided PCI incorporating the LL workflow (N=264), a structured algorithm using routine pre- and post-PCI OCT imaging, was compared with baseline angiography-only PCI (angio) (N=428). Propensity score analysis identified 207 matched procedures. Outcomes included procedure time, radiation exposure, contrast volume, device utilisation, and treatment strategy. RESULTS Compared with angiography alone, LL workflow OCT-guided PCI increased the median procedural time by 9 minutes but reduced vessel preparation time (2 min LL workflow vs 3 min angio; p<0.001) and resulted in less unplanned additional treatment (4% LL workflow vs 10% angio; p=0.01). With LL workflow OCT guidance, fewer cineangiography views were needed compared to angiography guidance, leading to decreased radiation exposure (1,133 mGy LL workflow vs 1,269 mGy angio; p=0.02), with no difference in contrast utilisation between groups (p=0.28). Furthermore, LL workflow OCT guidance resulted in fewer predilatation balloons and stents being used, more direct stent placement, and greater stent post-dilatation than angiography-guided PCI. CONCLUSIONS The incorporation of a standardised pre- and post-PCI OCT imaging workflow improves procedural efficiency and safety metrics, at a cost of a modestly longer procedure time.
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Affiliation(s)
- Eric A Osborn
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael Johnson
- Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Aziz Maksoud
- Cardiovascular Research Institute of Kansas, University of Kansas School of Medicine, Wichita, KS, USA
- Kansas Heart Hospital, Wichita, KS, USA
| | - Daniel Spoon
- International Heart Institute of Montana, Missoula, MT, USA
| | | | | | | | | | | | | | - Judah Rauch
- Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY, USA
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Intravascular Imaging During Percutaneous Coronary Intervention: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:590-605. [PMID: 36754518 DOI: 10.1016/j.jacc.2022.11.045] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 02/09/2023]
Abstract
Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). Adjunctive use of contemporary intravascular imaging (IVI) technologies has emerged as a complement to conventional angiography-to further characterize plaque morphology and optimize the performance of PCI. IVI has utility for preintervention lesion and vessel assessment, periprocedural guidance of lesion preparation and stent deployment, and postintervention assessment of optimal endpoints and exclusion of complications. The role of IVI in reducing major adverse cardiac events in complex lesion subsets is emerging, and further studies evaluating broader use are underway or in development. This paper provides an overview of currently available IVI technologies, reviews data supporting their utilization for PCI guidance and optimization across a variety of lesion subsets, proposes best practices, and advocates for broader use of these technologies as a part of contemporary practice.
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10
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Bergmark B, Dallan LA, Pereira GT, Kuder JF, Murphy SA, Buccola J, Wollmuth J, Lopez J, Spinelli J, Meinen J, West NE, Croce K. Decision-Making During Percutaneous Coronary Intervention Guided by Optical Coherence Tomography: Insights From the LightLab Initiative. Circ Cardiovasc Interv 2022; 15:872-881. [PMID: 36378739 PMCID: PMC9648988 DOI: 10.1161/circinterventions.122.011851] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Use of intracoronary imaging is associated with improved outcomes in patients undergoing percutaneous coronary intervention (PCI). Yet, the impact of intracoronary imaging on real-time physician decision-making during PCI is not fully known. METHODS The LightLab Initiative is a multicenter, prospective, observational study designed to characterize the use of a standardized optical coherence tomography (OCT) workflow during PCI. Participating physicians performed pre-PCI and post-PCI OCT in accordance with this workflow and operator assessments of lesion characteristics and treatment plan were recorded for each lesion based on angiography alone and following OCT. Physicians were categorized as having low (n=15), intermediate (n=13), or high (n=14) OCT use in the year preceding participation. RESULTS Among 925 patients with 1328 lesions undergoing PCI, the prescribed OCT workflow was followed in 773 (84%) of patients with 836 lesions. Operator lesion assessment and decision-making during PCI changed with OCT use in 86% (721/836) of lesions. Pre-PCI OCT use changed operator decision-making in 80% of lesions, including lesion assessment (45%), vessel preparation strategy (27%), stent diameter (37%), and stent length (36%). Post-PCI OCT changed stent optimization decision-making in 31% of lesions. These findings were consistent across strata of physician prior OCT experience. CONCLUSIONS A standardized OCT workflow impacted PCI decision-making in 86% of lesions, with a predominant effect on pre-PCI lesion assessment and planning of treatment strategy. This finding was consistent regardless of operator experience level and provides insight into mechanisms by which intravascular imaging might improve PCI outcomes.
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Affiliation(s)
- Brian Bergmark
- CTO/Complex Coronary Intervention Program, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (B.B., K.C.).,Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston (B.B., J.F.K., S.A.M.)
| | - Luis A.P. Dallan
- University Hospitals Cleveland Medical Center, OH (L.A.P.D., G.T.R.P.)
| | | | - Julia F. Kuder
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston (B.B., J.F.K., S.A.M.)
| | - Sabina A. Murphy
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston (B.B., J.F.K., S.A.M.)
| | - Jana Buccola
- Abbott Vascular, Santa Clara, CA (J.B., J.S., J.M., N.E.J.W.)
| | | | - John Lopez
- Loyola University Medical Center, Maywood, IL (J.L.)
| | - Joia Spinelli
- Abbott Vascular, Santa Clara, CA (J.B., J.S., J.M., N.E.J.W.)
| | - Jennifer Meinen
- Abbott Vascular, Santa Clara, CA (J.B., J.S., J.M., N.E.J.W.)
| | - Nick E.J. West
- Abbott Vascular, Santa Clara, CA (J.B., J.S., J.M., N.E.J.W.)
| | - Kevin Croce
- CTO/Complex Coronary Intervention Program, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (B.B., K.C.)
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11
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Khuddus MA, Darki A, Padaliya BB, West NEJ, Rapoza RJ, Buccola J, Amis G, Chehab BM, Secemsky EA. Improving efficiency and operator proficiency during percutaneous coronary interventions utilizing a standardized optical coherence tomography workflow. Catheter Cardiovasc Interv 2022; 100 Suppl 1:S14-S24. [PMID: 36661365 DOI: 10.1002/ccd.30392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study was designed to compare efficiency and quality metrics between percutaneous coronary intervention (PCI) procedures using optical coherence tomography (OCT) guided by a variable workflow versus a standardized workflow in a real-world population. BACKGROUND The LightLab (LL) Initiative was designed to evaluate the impact of a standardized OCT workflow during PCI to address barriers to adoption. METHODS The LL Initiative was a multicenter, prospective, observational study. PCI efficiency data were collected from 1/21/19 to 1/8/21 from 45 physicians at 17 US centers. OCT-guided PCIs were compared between baseline phase (variable workflow; N = 383) and the LL workflow utilization phase (N = 447). The LL workflow uses OCT to assess lesion Morphology, Length and Diameter, and then optimize outcomes by correcting for Medial dissection, stent mal-Apposition, and under-eXpansion (MLD MAX). Matching based on propensity scores was used to control for differences between PCIs. RESULTS After propensity matching, 291 paired procedures were included. Integration of the LL versus variable workflow resulted in no difference in procedure time (51 min vs. 51 min, p = 0.93). There was a reduction in radiation exposure (1124 mGy vs. 1493 mGy, p < 0.0001) and contrast volume (160 cc vs. 172 cc, p < 0.001). The LL workflow decreased the proportion of underexpanded lesions (34% vs. 54%, p < 0.0001) and improved minimum stent expansion (85% vs. 79%, p < 0.0001). Number of noncompliant balloons used was reduced with the LL workflow. (2.0 vs. 1.7, p < 0.01). CONCLUSIONS These data suggest that standardizing imaging with the LL workflow may overcome barriers to imaging and improve PCI outcomes without prolonging procedures.
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Affiliation(s)
- Matheen A Khuddus
- The Cardiac and Vascular Institute, Gainesville, Florida, USA
- HCA Florida North Florida Hospital, Gainesville, Florida, USA
| | - Amir Darki
- Loyola University Medical Center and Loyola Stritch School of Medicine, Maywood, Illinois, USA
| | - Bimal B Padaliya
- HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale, Arizona, USA
| | | | | | | | | | - Bassem M Chehab
- Ascension Via Christi Hospital, Cardiovascular Research Institute of Kansas, Wichita, Kansas, USA
| | - Eric A Secemsky
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Four-Year Outcomes of Left Main Percutaneous Coronary Intervention with a Bioresorbable Scaffold in the Circumflex Ostium. J Interv Cardiol 2022; 2022:7934868. [DOI: 10.1155/2022/7934868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives. The study aimed to investigate the long-term outcomes of a double stent scaffold strategy in patients with left main (LM) bifurcation lesions involving the ostium of the left circumflex artery (LCX), utilizing a drug-eluting stent (DES) in the LM extending into the left anterior descending artery (LAD) and a bioresorbable vascular scaffold (BVS) in the LCX ostium. Background. The high occurrence of in-stent restenosis of the LCX ostium is the major limitation of percutaneous coronary intervention (PCI) for LM lesions with a two-stent strategy. Methods. This was a single-center, prospective, single-arm study of 46 consecutively enrolled patients with a stable coronary artery disease and significant unprotected LM distal bifurcation disease. Patients underwent imaging-guided PCI using DES in the LM-LAD and BVS in the LCX using a T-stent or mini-crush technique. The primary outcome at four years was the composite of death, myocardial infarction, stroke, and target lesion revascularization (TLR). Results. At four years, the primary outcome was identified in 9 patients (19.6%). All events were TLRs except one myocardial infarction due to BVS thrombosis. Seven of the eight TLRs were a result of side branch BVS restenosis. Univariate predictors of the 4-year outcome were higher LDL cholesterol and BVS size ≤2.5 mm. On multivariate analysis, LCX lesion preparation with a cutting balloon and post-procedure use of intravascular ultrasound for optimization were found to be independent protective factors of MACE. Conclusions. In selected patients with LM distal bifurcation disease, an imaging-guided double stent scaffold strategy with DES in the LM and BVS in the LCX ostium was technically successful in all patients and was reasonably safe and effective for four years.
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Park DW, Kang DY, Ahn JM, Yun SC, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Yoon JH, Choi JW, Kim KS, Choi SW, Lee SN, Park SJ. Routine Functional Testing or Standard Care in High-Risk Patients after PCI. N Engl J Med 2022; 387:905-915. [PMID: 36036496 DOI: 10.1056/nejmoa2208335] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. METHODS We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. RESULTS The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). CONCLUSIONS Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.).
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Affiliation(s)
- Duk-Woo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Do-Yoon Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Min Ahn
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Sung-Cheol Yun
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Yong-Hoon Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Ho Hur
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Cheol Hyun Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Won-Jang Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Se Hun Kang
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Chul Soo Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Bong-Ki Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung-Won Suh
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jung Han Yoon
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Jae Woong Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Kee-Sik Kim
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Si Wan Choi
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Su Nam Lee
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
| | - Seung-Jung Park
- From the Divisions of Cardiology (D.-W.P., D.-Y.K., J.-M.A., S.-J.P.) and Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital (C.S.P.), and the Division of Cardiology, Eulji General Hospital (J.W.C.), Seoul, the Division of Cardiology, Chungnam National University Sejong Hospital, Sejong (Y.-H.Y.), the Division of Cardiology, Keimyung University Dongsan Hospital (S.-H.H., C.H.L.), and the Division of Cardiology, Daegu Catholic University Medical Center (K.-S.K.), Daegu, the Division of Cardiology, CHA Bundang Medical Center (W.-J.K., S.H.K.), and the Cardiovascular Center, Seoul National University Bundang Hospital (J.-W.S.), Seongnam, the Division of Cardiology, Kangwon National University Hospital, Chuncheon (B.-K.L.), the Division of Cardiology, Wonju Severance Christian Hospital, Wonju (J.H.Y.), the Division of Cardiology, Chungnam National University Hospital, Daejeon (S.W.C.), and the Division of Cardiology, St. Vincent's Hospital, Suwon (S.N.L.) - all in South Korea
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Abouelnour A, Gori T. Intravascular imaging in coronary stent restenosis: Prevention, characterization, and management. Front Cardiovasc Med 2022; 9:843734. [PMID: 36017094 PMCID: PMC9395642 DOI: 10.3389/fcvm.2022.843734] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the introduction of drug-eluting stents to combat the neointimal hyperplasia that occurred after BMS implantation, in-stent restenosis is still encountered in a significant number of patients, particularly as increasingly complex lesions are tackled by percutaneous coronary intervention. Many biological and mechanical factors interplay to produce restenosis, some of which are avoidable. Intravascular imaging provided unique insights into various forms of stent-related mechanical issues that contribute to this phenomenon. From a practical perspective, intravascular imaging can therefore help to optimize the stenting procedure to avert these issues. Moreover, once the problem of restenosis eventuates, imaging can guide the management by tackling the underlying identified mechanism. Finally, it can be used to evaluate the re-intervention results. Nevertheless, with the emergence of different treatment options, more evidence is needed to define patient/lesion-specific characteristics that may help to tailor treatment selection in a way that improves clinical outcomes.
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Affiliation(s)
- Amr Abouelnour
- Zentrum für Kardiologie, Kardiologie I, Deutsches Zentrum für Herz und Kreislauf Forschung, University Medical Center Mainz, Mainz, Germany
- Department of Cardiovascular Medicine, Cardiovascular Institute, Assiut University, Assiut, Egypt
| | - Tommaso Gori
- Zentrum für Kardiologie, Kardiologie I, Deutsches Zentrum für Herz und Kreislauf Forschung, University Medical Center Mainz, Mainz, Germany
- *Correspondence: Tommaso Gori,
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Hollowed J, Parikh RV. The Long Road to Optimal Stenting of Diffuse Coronary Artery Lesions. JACC: ASIA 2022; 2:457-459. [PMID: 36339365 PMCID: PMC9627841 DOI: 10.1016/j.jacasi.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Comparison of Different Types of Drug-Eluting Stents for De Novo Long Coronary Artery Lesions. JACC: ASIA 2022; 2:446-456. [PMID: 36339368 PMCID: PMC9627890 DOI: 10.1016/j.jacasi.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022]
Abstract
Background Outcomes of percutaneous coronary intervention for diffuse long lesions remain relatively unfavorable. Prior clinical trials investigated the relative efficacy and safety of different types of drug-eluting stents (DES) in long lesions. Objectives This study sought to compare the relative performance of different types of DES for de novo long (≥25 mm) coronary artery lesions. Methods Using a pooled analysis of individual data of 1,450 patients from 3 randomized clinical trials, we compared angiographic and clinical outcomes of 5 different types of DES: 224 patients with cobalt-chromium everolimus-eluting stents (EES), 255 with platinum-chromium EES, 250 with Resolute zotarolimus-eluting stents, 245 with biodegradable polymer biolimus-eluting stents, and 476 with first-generation sirolimus-eluting stents (SES). The primary endpoint was in-segment late lumen loss at 9 months. Results The primary endpoint was not significantly different between 4 second-generation DES and 1 first-generation SES (0.17 ± 0.41 mm in cobalt-chromium EES; 0.11 ± 0.37 in platinum-chromium EES: 0.14 ± 0.38 in Resolute zotarolimus-eluting stents; 0.14 ± 0.38 in biodegradable polymer biolimus-eluting stents; or 0.10 ± 0.37 in SES, respectively, overall P = 0.38). Also, there were no significant between-group differences with respect to death, myocardial infarction, target-vessel revascularization, or stent thrombosis at 12 months. In the multiple treatment propensity-score analysis, the risk of angiographic and clinical outcomes was also similar among several types of DES. Conclusions In this patient-level pooled analysis, several second-generation DES showed similar angiographic and clinical outcomes in patients with de novo long coronary lesions. (Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-III [LONG-DES-III]; NCT01078038; Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-IV [LONG-DES-IV]; NCT01186094; and Everolimus-eluting [PROMUS-ELEMENT] vs. Biolimus A9-Eluting [NOBORI] Stents for Long-Coronary Lesions [LONG-DES-V]; NCT01186120)
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17
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Lee S, Zhang J, Mintz GS, Hong S, Ahn C, Kim J, Kim B, Ko Y, Choi D, Jang Y, Kan J, Pan T, Gao X, Ge Z, Chen S, Hong M. Procedural Characteristics of Intravascular Ultrasound–Guided Percutaneous Coronary Intervention and Their Clinical Implications. J Am Heart Assoc 2022; 11:e025258. [PMID: 35861828 PMCID: PMC9707812 DOI: 10.1161/jaha.122.025258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Despite the clinical benefits to intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI), most patients with coronary artery disease undergo angiography‐guided PCI alone in the real‐world setting. We sought to investigate the procedural characteristics of IVUS‐guided PCI and their clinical outcomes, as compared with angiography‐guided PCI.
Methods and Results
This was a cohort study using patient‐level data from the IVUS‐XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All‐Comers Coronary Lesions) clinical trials. A total of 2848 patients with 3872 native coronary lesions were included and procedural characteristics assessed by quantitative coronary angiography (QCA) were compared between IVUS and angiography guidance. Stent‐to‐reference vessel diameter ratio (ie, QCA stent sizing) was greater (1.11±0.16 versus 1.07±0.14,
P
<0.001) and high‐pressure postdilation was more frequently performed (83.7% versus 75.4%,
P
<0.001) with IVUS guidance, whereas residual stent edge dissections were more frequent in lesions treated with IVUS guidance (4.6% versus 0.7%,
P
<0.001). Given the dissection risk, optimal QCA stent sizing for IVUS guidance was a stent‐to‐QCA reference vessel diameter ratio ≥1.1 to <1.3. Among 1424 patients (1969 lesions) treated with angiography guidance, QCA stent sizing <1.0 was observed in 651 (33.1%) lesions, while QCA stent sizing ≥1.1 to <1.3 was observed in only 526 (26.7%) lesions. Under angiography guidance, patients with both QCA stent sizing ≥1.1 to <1.3 and high‐pressure postdilation (235 of 1424, 16.5%) had a lower risk of 3‐year target lesion failure compared with others (hazard ratio, 0.532; 95% CI, 0.293–0.966 [
P
=0.038]).
Conclusions
IVUS‐guided PCI resulted in larger QCA‐assessed stent sizing and more frequent postdilation with high‐pressure inflations. These procedures may further improve long‐term clinical outcomes in patients undergoing PCI without IVUS.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01308281 (IVUS‐XPL); NCT02215915 (ULTIMATE).
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Affiliation(s)
- Seung‐Yul Lee
- Regional Cardiocerebrovascular CenterWonkwang University Hospital Iksan Korea
| | - Jun‐Jie Zhang
- Nanjing First HospitalNanjing Medical University Nanjing China
| | | | - Sung‐Jin Hong
- Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Korea
| | - Chul‐Min Ahn
- Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Korea
| | - Jung‐Sun Kim
- Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Korea
| | - Byeong‐Keuk Kim
- Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Korea
| | - Young‐Guk Ko
- Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Korea
| | - Donghoon Choi
- Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Korea
| | - Yangsoo Jang
- CHA University College of Medicine Seongnam Korea
| | - Jing Kan
- Nanjing First HospitalNanjing Medical University Nanjing China
| | - Tao Pan
- Nanjing First HospitalNanjing Medical University Nanjing China
| | - Xiaofei Gao
- Nanjing First HospitalNanjing Medical University Nanjing China
| | - Zhen Ge
- Nanjing First HospitalNanjing Medical University Nanjing China
| | - Shao‐Liang Chen
- Nanjing First HospitalNanjing Medical University Nanjing China
| | - Myeong‐Ki Hong
- Severance Cardiovascular HospitalYonsei University College of Medicine Seoul Korea
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18
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Lee YJ, Zhang JJ, Mintz GS, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Kan J, Pan T, Gao X, Ge Z, Chen SL, Hong MK. Is Routine Postdilation During Angiography-Guided Stent Implantation as Good as Intravascular Ultrasound Guidance?: An Analysis Using Data From IVUS-XPL and ULTIMATE. Circ Cardiovasc Interv 2022; 15:e011366. [PMID: 35041452 DOI: 10.1161/circinterventions.121.011366] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are 2 competing approaches to optimize drug-eluting stent implantation: angiography-guided routine postdilation or intravascular ultrasound (IVUS) guidance. METHODS From the pooled data of 2 randomized trials, IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) and ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in All-Comers Coronary Lesions), that compared IVUS- versus angiography-guided drug-eluting stent implantation, we compared 1037 patients (1265 lesions) with IVUS-guided postdilation, 905 patients (1170 lesions) with angiography-guided postdilation, and 383 patients (397 lesions) with angiography-guided drug-eluting stent implantation without postdilation as a reference group; all patients required ≥28 mm long stents. The primary end point was composite of cardiac death, target lesion-related myocardial infarction, or ischemia-driven target lesion revascularization at 3 years. RESULTS Postintervention quantitative coronary angiography-based minimum lumen diameter was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (2.5±0.4 mm versus 2.5±0.4 mm; P=0.367). However, it was larger in the IVUS guidance with postdilation versus the angiography guidance without postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; P=0.046), and also in the IVUS guidance with postdilation versus the angiography guidance with postdilation group (2.6±0.5 mm versus 2.5±0.4 mm; P<0.001). The rate of the primary end point was not different between the angiography guidance with postdilation versus the angiography guidance without postdilation group (8.6% versus 9.8%; hazard ratio, 0.86 [95% CI, 0.58-1.29]; P=0.473). However, it was lower after IVUS guidance with postdilation versus angiography guidance without postdilation (4.5% versus 9.8%; hazard ratio, 0.44 [95% CI, 0.28-0.68]; P<0.001) and also after IVUS guidance with postdilation versus angiography guidance with postdilation (4.5% versus 8.6%; hazard ratio, 0.51 [95% CI, 0.35-0.74]; P<0.001). CONCLUSIONS In patients undergoing long drug-eluting stent implantation, IVUS-guided postdilation was associated with improved long-term clinical outcomes, unlike angiography-guided postdilation.
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Affiliation(s)
- Yong-Joon Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Jun-Jie Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.-J.Z., J.K., T.P., X.G., Z.G,. S.-L.C.)
| | | | - Sung-Jin Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Chul-Min Ahn
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.-J.Z., J.K., T.P., X.G., Z.G,. S.-L.C.)
| | - Tao Pan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.-J.Z., J.K., T.P., X.G., Z.G,. S.-L.C.)
| | - Xiaofei Gao
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.-J.Z., J.K., T.P., X.G., Z.G,. S.-L.C.)
| | - Zhen Ge
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.-J.Z., J.K., T.P., X.G., Z.G,. S.-L.C.)
| | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.-J.Z., J.K., T.P., X.G., Z.G,. S.-L.C.)
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
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19
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Watanabe Y, Mitomo S, Naganuma T, Chieffo A, Montorfano M, Nakamura S, Colombo A. The importance of proximal optimization technique with intravascular imaging guided for stenting unprotected left main distal bifurcation lesions: The Milan and New-Tokyo registry. Catheter Cardiovasc Interv 2021; 98:E814-E822. [PMID: 34520089 DOI: 10.1002/ccd.29954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study evaluated the 5-years outcomes of intracoronary imaging-guided proximal optimization technique (POT) for percutaneous coronary intervention (PCI) in patients with unprotected left main distal bifurcation lesions (ULMD). BACKGROUND The long-term effects of POT with intracoronary imaging guide in PCI for ULMD have been unclear. METHODS Between January 2005 and December 2015, we identified 1832 consecutive patients who underwent DES implantation for ULM distal bifurcation lesions. Of them, 780 (56.1%) patients underwent POT with intravascular imaging guidance (optimal expansion group). Residual 611 (43.9%) patients did not undergo either POT or intravascular imaging or both (suboptimal expansion group). Analysis using propensity score adjustment was performed. The primary endpoint was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. RESULTS TLF rate at 5 years was significantly lower in optimal expansion group than that in suboptimal expansion group [adjusted HR 0.65, 95% CI (0.48-0.87), p = 0.004]. Cardiac mortality was significantly lower in optimal expansion group than that in suboptimal expansion group [adjusted HR 0.46, 95% CI (0.27-0.79), p = 0.004]. The multivariable analysis identified POT with intravascular imaging guide [adjusted HR 0.65, 95% CI (0.48-0.87), p = 0.004] as an independent predictor of TLF. CONCLUSIONS Intravascular imaging guided POT was strongly associated with the reduced risk of TLF at 5 years after PCI for ULMD, mainly driven by reducing cardiac mortality.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, Maria Cecilia Hospital GVM, Cotignola, Italy
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20
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Lee YJ, Zhang JJ, Mintz GS, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Kan J, Pan T, Gao X, Ge Z, Chen SL, Hong MK. Impact of Intravascular Ultrasound-Guided Optimal Stent Expansion on 3-Year Hard Clinical Outcomes. Circ Cardiovasc Interv 2021; 14:e011124. [PMID: 34665657 DOI: 10.1161/circinterventions.121.011124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Yong-Joon Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Jun-Jie Zhang
- Nanjing First Hospital, Nanjing Medical University, China (J.-J.Z., J.K., T.P., X.G., Z.G., S.-L.C.)
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Sung-Jin Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Chul-Min Ahn
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, China (J.-J.Z., J.K., T.P., X.G., Z.G., S.-L.C.)
| | - Tao Pan
- Nanjing First Hospital, Nanjing Medical University, China (J.-J.Z., J.K., T.P., X.G., Z.G., S.-L.C.)
| | - Xiaofei Gao
- Nanjing First Hospital, Nanjing Medical University, China (J.-J.Z., J.K., T.P., X.G., Z.G., S.-L.C.)
| | - Zhen Ge
- Nanjing First Hospital, Nanjing Medical University, China (J.-J.Z., J.K., T.P., X.G., Z.G., S.-L.C.)
| | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, China (J.-J.Z., J.K., T.P., X.G., Z.G., S.-L.C.)
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
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21
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Lee JM, Lee SH, Kim J, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi JH, Choi SH, Kim HS, Chun WJ, Nam CW, Hur SH, Han SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Lim DS, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Hong SJ, Koo BK, Gwon HC. Ten-Year Trends in Coronary Bifurcation Percutaneous Coronary Intervention: Prognostic Effects of Patient and Lesion Characteristics, Devices, and Techniques. J Am Heart Assoc 2021; 10:e021632. [PMID: 34514841 PMCID: PMC8649555 DOI: 10.1161/jaha.121.021632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Despite advances in devices and techniques, coronary bifurcation lesion remains a challenging lesion subset in the field of percutaneous coronary intervention (PCI). We evaluate 10‐year trends in bifurcation PCI and their effects on patient outcomes. Methods and Results We analyzed 10‐year trends in patient/lesion characteristics, devices, PCI strategy, stent optimization techniques, and clinical outcomes using data from 5498 patients who underwent bifurcation PCI from 2004 to 2015. Clinical outcomes 2 years after the index procedure were evaluated in terms of target vessel failure (a composite of cardiac death, myocardial infarction, and target vessel revascularization) and a patient‐oriented composite outcome (a composite of all‐cause death, myocardial infarction, and any revascularization). During the 10‐year study period, patient and lesion complexity, such as multivessel disease, diabetes mellitus, chronic kidney disease, and left main bifurcation, increased continuously (all P<0.001). The risk of target vessel failure or patient‐oriented composite outcome decreased continuously from 2004 to 2015 (target vessel failure: from 12.3% to 6.9%, log‐rank P<0.001; patient‐oriented composite outcome: from 13.6% to 9.3%, log‐rank P<0.001). The use of a second‐generation drug‐eluting stent and decreased target vessel failure risk in true bifurcation lesions were the major contributors to improved patient prognosis (interaction P values were <0.001 and 0.013, respectively). Conclusions During the past decade of bifurcation PCI, patient and lesion characteristics, devices, PCI techniques, and patient prognosis have all significantly changed. Despite increased patient and lesion complexity, clinical outcomes after bifurcation PCI have improved, mainly because of better devices and more widespread adoption of procedural optimization techniques and appropriate treatment strategies. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01642992 and NCT03068494.
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22
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Ali Z, Karimi Galougahi K, Mintz GS, Maehara A, Shlofmitz R, Mattesini A. Intracoronary optical coherence tomography: state of the art and future directions. EUROINTERVENTION 2021; 17:e105-e123. [PMID: 34110288 PMCID: PMC9725016 DOI: 10.4244/eij-d-21-00089] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Optical coherence tomography (OCT) has been increasingly utilised to guide percutaneous coronary intervention (PCI). Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited. Difficulty in transitioning from intravascular ultrasound (IVUS), complex image interpretation, lack of a standardised algorithm for PCI guidance, and paucity of data from prospective clinical trials have contributed to the modest adoption. Herein, we provide a comprehensive up-do-date overview on the utility of OCT in coronary artery disease, including technical details, device set-up, simplified OCT image interpretation, recognition of the imaging artefacts, and an algorithmic approach for using OCT in PCI guidance. We discuss the utility of OCT in acute coronary syndromes, provide a summary of the clinical trial data, list the work in progress, and discuss the future directions.
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Affiliation(s)
- Ziad Ali
- St. Francis Hospital and Heart Center 100 Port Washington Blvd., Roslyn, NY 11576, USA
| | | | - Gary S. Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Richard Shlofmitz
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Alessio Mattesini
- Structural Interventional Cardiology Unit, Careggi University Hospital, Florence, Italy
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23
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Hong MK, Lee SY. Intravascular Ultrasound for Percutaneous Coronary Intervention: Benefits and Limitations. JACC Cardiovasc Interv 2021; 14:258-260. [PMID: 33541536 DOI: 10.1016/j.jcin.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
| | - Seung-Yul Lee
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea
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24
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Gao XF, Ge Z, Kong XQ, Kan J, Han L, Lu S, Tian NL, Lin S, Lu QH, Wang XY, Li QH, Liu ZZ, Chen Y, Qian XS, Wang J, Chai DY, Chen CH, Pan T, Ye F, Zhang JJ, Chen SL. 3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2020; 14:247-257. [PMID: 33541535 DOI: 10.1016/j.jcin.2020.10.001] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to explore the difference in target vessel failure (TVF) 3 years after intravascular ultrasound (IVUS) guidance versus angiographic guidance among all comers undergoing second-generation drug-eluting stent (DES) implantation. BACKGROUND The multicenter randomized ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in "All-Comers" Coronary Lesions) trial showed a lower incidence of 1-year TVF after IVUS-guided DES implantation among all comers compared with angiographic guidance. However, the 3-year clinical outcomes of the ULTIMATE trial remain unknown. METHODS A total of 1,448 all comers undergoing DES implantation who were randomly assigned to either IVUS guidance or angiographic guidance in the ULTIMATE trial were followed for 3 years. The primary endpoint was the risk for TVF at 3 years. The safety endpoint was definite or probable stent thrombosis (ST). RESULTS At 3 years, TVF occurred in 47 patients (6.6%) in the IVUS-guided group and in 76 patients (10.7%) in the angiography-guided group (p = 0.01), driven mainly by the decrease in clinically driven target vessel revascularization (4.5% vs. 6.9%; p = 0.05). The rate of definite or probable ST was 0.1% in the IVUS-guided group and 1.1% in the angiography-guided group (p = 0.02). Notably, the IVUS-defined optimal procedure was associated with a significant reduction in 3-year TVF relative to that with the suboptimal procedure. CONCLUSIONS IVUS-guided DES implantation was associated with significantly lower rates of TVF and ST during 3-year follow-up among all comers, particularly those who underwent the IVUS-defined optimal procedure compared with those with angiographic guidance. (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in "All-Comers" Coronary Lesions; NCT02215915).
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Affiliation(s)
- Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiang-Quan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Kan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Leng Han
- Department of Cardiology, Changshu No. 1 People's Hospital, Changshu, China
| | - Shu Lu
- Department of Cardiology, The First People's Hospital of Taicang, Taicang, China
| | - Nai-Liang Tian
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Song Lin
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qing-Hua Lu
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, China
| | - Xiao-Yan Wang
- Department of Cardiology, Wuxi Third People's Hospital, Wuxi, China
| | - Qi-Hua Li
- Department of Cardiology, Changzhou Traditional Chinese Medicine Hospital, Changzhou, China
| | - Zhi-Zhong Liu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Chen
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xue-Song Qian
- Department of Cardiology, The First People's Hospital of Zhangjiagang, Zhangjiagang, China
| | - Juan Wang
- Department of Cardiology, Changshu No. 1 People's Hospital, Changshu, China
| | - Da-Yang Chai
- Department of Cardiology, The First People's Hospital of Taicang, Taicang, China
| | - Chong-Hao Chen
- Department of Cardiology, Wuxi Third People's Hospital, Wuxi, China
| | - Tao Pan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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25
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Fearon WF, Ahn JM. When is Coronary Revascularization Complete? Circ Cardiovasc Interv 2020; 13:e009889. [PMID: 32895007 DOI: 10.1161/circinterventions.120.009889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, CA (W.F.F., J.-M.A.)
| | - Jung-Min Ahn
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, CA (W.F.F., J.-M.A.).,Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A.)
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26
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Colombo A, Khokhar AA, Laricchia A. Optimal Stenting Is the Gold Standard: We Have Plenty of Data and New Questions Arise. JACC Cardiovasc Interv 2020; 13:1414-1416. [PMID: 32473883 DOI: 10.1016/j.jcin.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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